A Case Report on Dengue-Viral Encephalitis with Bilateral Optic Neuropathy Leading to Ophthalmoplegia and Sepsis

Wajeeha Qhudsia Siddiqua, Sameera Fatima, Ayesha Ambereen, Ayesha Asif Ali, Praveen Kumar Kulkarni

Abstract: We present a case of Dengue IgM Antibody-positive viral encephalitis accompanied by bilateral optic neuropathy, ophthalmoplegia, and sepsis, alongside severe thrombocytopenia. MRI findings indicated mild diffuse age-related cerebral atrophy with small vessel ischemic changes and chronic lacunar infarcts, as well as restricted diffusion along the anterior aspect of the intraorbital segments of both optic nerves (with the right being more affected than the left). Visual Evoked Potentials (VEP) revealed abnormalities in the bilateral visual pathway. Subsequently, the patient experienced a gradual loss of complete vision, manifesting only the perception of light, non-reacting pupils, and anisocoria. MRI of the orbit confirmed bilateral optic neuropathy, while alternate-day platelet monitoring demonstrated severe thrombocytopenia concurrent with sepsis.

Keywords: Encephalopathy, dengue fever, ophthalmoplegia, thrombocytopenia, sepsis, optic neuropathy